The mediating role of difficulties in emotion regulation in the relationship between childhood trauma and resilience among university students

Abstract

Contrary to the common belief that traumatic experiences always lead to psychopathology, most individuals with such experiences can actually recover from their traumas. Factors leading to a person's resilience are countless, but one of the important factors explaining why some individuals do not develop any kind of pathology in the face of trauma is emotion regulation. The degree that a person experiences difficulty in emotion regulation is a predictive factor for his/her resilience in the face of adverse childhood events, such as abuse and neglect. The purpose of this study was to examine the relationships among childhood traumas, difficulties in emotion regulation, and resilience among university students. The analysis was conducted with 404 participants. The demographic form, Childhood Trauma Questionnaire, Difficulties in Emotion Regulation Questionnaire Brief Form, and Connor-Davidson Resilience Scale were used for data collection. The results confirmed that difficulties in emotion regulation mediated the relationship between childhood traumas and resilience. Childhood trauma affected the resilience of participants depending on the level of the difficulties they experienced in emotion regulation.

Keywords

• childhood trauma
• difficulties in emotion regulation
• resilience
• university students
• mediation analysis

References

1. Afifi, T. O., & Macmillan, H. L. (2011). Resilience following child maltreatment: A review of protective factors. Canadian Journal of Psychiatry, 56(5), 266–272. https://doi.org/10.1177/0706743P1105600505
2. Akpınar, B., & Gümüş-Demir, Z. (2022). Üniversite öğrencilerinde çocukluk çağı travmaları, aleksitimi ve duygu düzenleme güçlüğü arasındaki ilişkinin incelenmesi [Investigation of the relationship between childhood trauma, alexithymia, and emotion regulation difficulty in university students]. International Journal of Social Sciences, 6(26) 509-535.
3. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2) 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
4. Aydin, Y. E., Altindag, A., & Ozkan, M. (2009). Childhood traumatic events and dissociation in university students. International Journal of Psychiatry in Clinical Practice, 13(1), 25–30. https://doi.org/10.1080/13651500802331540
5. Berking, M., & Wupperman, P. (2012). Emotion regulation and mental health: Recent findings, current challenges, and future directions. Current Opinion in Psychiatry, 25 (2), 128–134.
6. Bernstein, D. P., Fink, L., Handelsman, L., Foote, J., Lovejoy, M., Wenzel, K., Sapareto, E., & Ruggiero, J. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. The American Journal of Psychiatry, 151(8), 1132–1136. https://doi.org/10.1176/ajp.151.8.1132
7. Bertele, N., Talmon, A., Gross, J. J., Schmahl, C., Schmitz, M., & Niedtfeld, I. (2022). Childhood maltreatment and borderline personality disorder: The mediating role of difficulties with emotion regulation. Journal of Personality Disorders, 36(3), 264–276. https://doi.org/10.1521/pedi.2022.36.3.264
8. Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L. G., Bjärehed, J., DiLillo, D., Messman-Moore, T., Gumpert, C. H., & Gratz, K. L. (2016). Development and validation of a brief version of the difficulties in emotion regulation scale: The DERS-16. Journal of Psychopathology and Behavioral Assessment, 38(2), 284–296. https://doi.org/10.1007/s10862-015-9514-x

9. Bostancı N., Albayrak B., Bakoğlu İ., & Çoban Ş. (2006). Üniversite öğrencilerinde çocukluk çağı travmalarının depresif belirtileri üzerine etkisi [The effect of childhood traumas on depressive symptoms among university students]. New Symposium Journal, 44(2), 189- 95.
10. Brockmeyer, T., Skunde, M., Wu, M., Bresslein, E., Rudofsky, G., Herzog, W., & Friederich, H. C. (2014). Difficulties in emotion regulation across the spectrum of eating disorders. Comprehensive Psychiatry, 55(3), 565–571. https://doi.org/10.1016/j.comppsych.2013.12.001
11. Burns, E. E., Fischer, S., Jackson, J. L., & Harding, H. G. (2012). Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms. Child Abuse & Neglect, 36(1), 32–39. https://doi.org/10.1016/j.chiabu.2011.08.005
12. Cameron, L. D., Carroll, P., & Hamilton, W. K. (2018). Evaluation of an intervention promoting emotion regulation skills for adults with persisting distress due to adverse childhood experiences. Child Abuse & Neglect, 79, 423–433. https://doi.org/10.1016/j.chiabu.2018.03.002
13. Chang, J. J., Ji, Y., Li, Y. H., Yuan, M. Y., & Su, P. Y. (2021). Childhood trauma and depression in college students: Mediating and moderating effects of psychological resilience. Asian Journal of Psychiatry, 65, 102824. https://doi.org/10.1016/j.ajp.2021.102824
14. Collishaw, S., Pickles, A., Messer, J., Rutter, M., Shearer, C., & Maughan, B. (2007). Resilience to adult psychopathology following childhood maltreatment: Evidence from a community sample. Child Abuse & Neglect, 31(3), 211–229. https://doi.org/10.1016/j.chiabu.2007.02.004
15. Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety, 18(2), 76–82. https://doi.org/10.1002/da.10113
16. Çavuşoğlu, F. (2020). Cinsiyet gruplarına göre çocukluk çağı travma düzeylerinin incelenmesi [Examination of childhood trauma levels by gender groups]. Journal of International Social Research, 13(73), 575-581.
17. DeBellis, M. D., Hooper, S. R., & Sapia, J. L. (2005). Early trauma exposure and the brain. In J. J. Vasterling, & C. Brewin (Eds.), Neuropsychology of PTSD: Biological, cognitive, and clinical perspectives (pp. 153–177). Guilford.
18. Derakhshanpour, F., Shahini, N., Hajebi, A., Vakili, M. A., & Heydari Yazdi, A. S. (2017). Demographic characteristics and risk actors of children and parents in child abuse subtypes: Findings from a psychosocial support department. Journal of Fundamentals of Mental Health, 19(6), 625-635.
19. Dereboy, Ç., Şahin-Demirkapı, E., Şakiroğlu, M., & Şafak-Öztürk, C. (2018). Çocukluk çağı travmalarının, kimlik gelişimi, duygu düzenleme güçlüğü ve psikopatoloji ile İlişkisi [The relationship between childhood traumas, identity development, difficulties in emotion regulation and psychopathology]. Türk Psikiyatri Dergisi, 29(4), 269-278. https://doi.org/10.5080/u20463
20. Doğruer, N., Gökkaya, F., Volkan, E., & Güleç, M. (2022). Psikolojik dayanıklılığın yordayıcıları: Çocukluk çağı travma yaşantıları ve affetme [Predictors of psychological resilience: Childhood trauma experiences and forgiveness]. Psikiyatride Güncel Yaklaşımlar, 14(1), 242-250. https://doi.org/10.18863/pgy.1160408
21. Dunn, E. C., Nishimi, K., Gomez, S. H., Powers, A., & Bradley, B. (2018). Developmental timing of trauma exposure and emotion dysregulation in adulthood: Are there sensitive periods when trauma is most harmful?. Journal of Affective Disorders, 227, 869–877. https://doi.org/10.1016/j.jad.2017.10.045
22. Flores, E., Cicchetti, D., & Rogosch, F. A. (2005). Predictors of resilience in maltreated and nonmaltreated Latino Children. Developmental Psychology, 41(2), 338–351. https://doi.org/10.1037/0012-1649.41.2.338
23. Giardino, A. P., Lyn, M. A. ve Giardino, E. (2010). Introduction: Child Abuse and Neglect. In A. Giardino, M. Lyn ve E. Giardino (Eds.) (2nd Ed.), A practical guide to the evaluation of child physical abuse and neglect (pp.3-30). Springer.
24. Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. Lancet, 373(9657), 68–81. https://doi.org/10.1016/S0140-6736(08)61706-7
25. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
26. Grella, C. E., Stein, J. A., & Greenwell, L. (2005). Associations among childhood trauma, adolescent problem behaviors, and adverse adult outcomes in substance-abusing women offenders. Psychology of Addictive Behaviors, 19(1), 43–53. https://doi.org/10.1037/0893-164X.19.1.43
27. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
28. Gross, J.J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299. https://doi.org/10.1037/1089-2680.2.3.271
29. Güleç, M. Y., Altintaş, M., İnanç, L., Bezgin, C. H., Koca, E. K., & Güleç, H. (2013). Effects of childhood trauma on somatization in major depressive disorder: The role of alexithymia. Journal of Affective Disorders, 146(1), 137–141. https://doi.org/10.1016/j.jad.2012.06.033
30. Güloğlu, B., Karaırmak, Ö., & Emiral, E. (2016). Çocukluk çağı travmalarının tinsellik ve affetme üzerindeki rolü [The role of spirituality and forgiveness in childhood trauma]. Anadolu Psikiyatri Dergisi, 17(4), 309-316.
31. Gürbüz, S. (2019). Sosyal bilimlerde aracı, düzenleyici ve durumsal etki analizleri [Mediator, moderator, and conditional process analysis in social sciences]. Seçkin.
32. Hayes, A.F. (2022). Introduction to mediation, moderation, and conditional process analysis. A regression-based approach. Guildford Press.
33. Helvacı Çelik, F. G., & Hocaoğlu Ç. (2018) Çocukluk çağı travmaları: Bir gözden geçirme [Childhood traumas: A review]. Sakarya Tıp Dergisi, 8(4), 695-711. https://doi.org/10.31832/smj.454535
34. Hemmingsson, E., Johansson, K., & Reynisdottir, S. (2014). Effects of childhood abuse on adult obesity: A systematic review and meta-analysis. Obesity Reviews, 15(11), 882–893. https://doi.org/10.1111/obr.12216
35. Herrman, H., Stewart, D. E., Diaz-Granados, N., Berger, E. L., Jackson, B., & Yuen, T. (2011). What is Resilience? The Canadian Journal of Psychiatry, 56(5), 258–265. https://doi.org/10.1177/070674371105600504
36. Hopfinger, L., Berking, M., Bockting, C. L., & Ebert, D. D. (2016). Emotion regulation mediates the effect of childhood trauma on depression. Journal of Affective Disorders, 198, 189–197. https://doi.org/10.1016/j.jad.2016.03.050
37. Howell, K. H., & Miller-Graff, L. E. (2014). Protective factors associated with resilient functioning in young adulthood after childhood exposure to violence. Child Abuse & Neglect, 38(12), 1985–1994. https://doi.org/10.1016/j.chiabu.2014.10.010
38. Huh, H. J., Kim, K. H., Lee, H. K., & Chae, J. H. (2017). The relationship between childhood trauma and the severity of adulthood depression and anxiety symptoms in a clinical sample: The mediating role of cognitive emotion regulation strategies. Journal of Affective Disorders, 213, 44–50. https://doi.org/10.1016/j.jad.2017.02.009
39. Jeynes, W. H. (2002). The challenge of controlling for SES in social science and education research. Educational Psychology Review, 14, 205–221. https://doi.org/10.1023/A:1014678822410
40. Kağıtçıbaşı, C., & Ataca, B. (2005). Value of children and family change: A three-decade portrait from Turkey. Applied Psychology: An International Review, 54(3), 317–337. https://doi.org/10.1111/j.1464-0597.2005.00213.x
41. Karaırmak O. (2010). Establishing the psychometric qualities of the Connor-Davidson Resilience Scale (CD-RISC) using exploratory and confirmatory factor analysis in a trauma survivor sample. Psychiatry Research, 179(3), 350–356. https://doi.org/10.1016/j.psychres.2009.09.012
42. Kaya, Ö. (2020). Çocukluk çağı travmalarının akılcı olmayan inançlar ve psikopatolojik belirtiler ile ilişkisinin incelenmesi (The relationship between childhood traumas and irrational beliefs and psychopathological symptoms) (Publication No. 10338389) [Master Thesis, Işık University]. Işık University Library. https://hdl.handle.net/11729/2945
43. Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51(6), 706–716. https://doi.org/10.1111/j.1469-7610.2009.02202.x
44. Kuo, J. R., Khoury, J. E., Metcalfe, R., Fitzpatrick, S., & Goodwill, A. (2015). An examination of the relationship between childhood emotional abuse and borderline personality disorder features: The role of difficulties with emotion regulation. Child Abuse & Neglect, 39, 147–155. https://doi.org/10.1016/j.chiabu.2014.08.008
45. Leech, N.L., Barret, K.C. & Morgan, G.A. (2015). IBM SPSS for intermediate Statistics: Use and interpretation (5th Ed.). Routledge.
46. Luthar, S.S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543-562. http://dx.doI.org/10.1111/1467-8624.00164
47. Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56(3), 227–238. https://doi.org/10.1037/0003-066X.56.3.227
48. McDermott, B. M., Lee, E. M., Judd, M., & Gibbon, P. (2005). Posttraumatic stress disorder and general psychopathology in children and adolescents following a wildfire disaster. Canadian Journal of Psychiatry, 50, 137–143.https://doi.org/10.1177/070674370505000302
49. McLaughlin, K. A., & Lambert, H. K. (2017). Child trauma exposure and psychopathology: Mechanisms of risk and resilience. Current Opinion in Psychology, 14, 29–34. https://doi.org/10.1016/j.copsyc.2016.10.004
50. Mestre, J. M., Núñez-Lozano, J. M., Gómez-Molinero, R., Zayas, A., & Guil, R. (2017). Emotion regulation ability and resilience in a sample of adolescents from a Suburban Area. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.01980
51. Michopoulos, V., Powers, A., Moore, C., Villarreal, S., Ressler, K. J., & Bradley, B. (2015). The mediating role of emotion dysregulation and depression on the relationship between childhood trauma exposure and emotional eating. Appetite, 91, 129–136. https://doi.org/10.1016/j.appet.2015.03.036
52. Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLOS Medicine, 9(11), e1001349 https://doi.org/10.1371/journal.pmed.1001349
53. Oakes, J. M, & Andrade, K. E. (2017). The measurement of socioeconomic status. In J. M. Oakes, & J. S. Kaufman (eds). Methods in social epidemiology (pp. 23–42). Jossey-Bass.
54. Örsel, S., Karadağ, H., Karaoğlan-Kahiloğulları, A., & Akgün-Aktaş, E. (2010). Psikiyatri hastalarında çocukluk çağı travmalarının sıklığı ve psikopatoloji ile ilişkisi [The frequency of childhood trauma and relationship with psychopathology in psychiatric patients]. Anadolu Psikiyatri Dergisi, 12(2), 130-136.
55. Pan, Y., Lin, X., Liu, J., Zhang, S., Zeng, X., Chen, F., & Wu, J. (2021). Prevalence of childhood sexual abuse among women using the childhood trauma questionnaire: A worldwide meta-Analysis. Trauma, Violence, & Abuse, 22(5), 1181–1191. https://doi.org/10.1177/1524838020912867
56. Patock-Peckham, J. A., Belton, D. A., D'Ardenne, K., Tein, J. Y., Bauman, D. C., Infurna, F. J., Sanabria, F., Curtis, J., Morgan-Lopez, A. A., & McClure, S. M. (2020). Dimensions of childhood trauma and their direct and indirect links to PTSD, impaired control over drinking, and alcohol-related-problems. Addictive Behaviors Reports, 12. https://doi.org/10.1016/j.abrep.2020.100304
57. Pearce, J., Murray, C., & Larkin, W. (2019). Childhood adversity and trauma: Experiences of professionals trained to routinely enquire about childhood adversity. Heliyon, 5(7), e01900. https://doi.org/10.1016/j.heliyon.2019.e01900
58. Perry, B. D., & Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation. A neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 7(1), 33-51. https://doi.org/10.1016/S1056-4993(18)30258-X
59. Preacher, K. J., & Kelly, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93-115.
60. Rutter, M. (1999). Resilience concepts and findings: Implications for family therapy. Journal of Family Therapy, 2, 119-144. http://dx.doi.org/10.1111/1467-6427.00108
61. Shi, L., Wang, Y., Yu, H., Wilson, A., Cook, S., Duan, Z., Peng, K., Hu, Z., Ou, J., Duan, S., Yang, Y., Ge, J., Wang, H., Chen, L., Zhao, K., & Chen, R. (2020). The relationship between childhood trauma and Internet gaming disorder among college students: A structural equation model. Journal of Behavioral Addictions, 9(1), 175–180. https://doi.org/10.1556/2006.2020.00002
62. Shields, A., & Cicchetti, D. (1998). Reactive aggression among maltreated children: the contributions of attention and emotion dysregulation. Journal of Clinical Child Psychology, 27(4), 381–395. https://doi.org/10.1207/s15374424jccp2704_2
63. Shorey, R. C., Brasfield, H., Febres, J., & Stuart, G. L. (2011). An examination of the association between difficulties with emotion regulation and dating violence perpetration. Journal of Aggression, Maltreatment & Trauma, 20(8), 870–885. https://doi.org/10.1080/10926771.2011.629342
64. Stevens, N. R., Gerhart, J., Goldsmith, R. E., Heath, N. M., Chesney, S. A., & Hobfoll, S. E. (2013). Emotion regulation difficulties, low social support, and interpersonal violence mediate the link between childhood abuse and posttraumatic stress symptoms. Behavior Therapy, 44(1), 152–161. https://doi.org/10.1016/j.beth.2012.09.003
65. Stewart, M., Reid, G., & Mangham, C. (1997). Fostering children’s resilience. Journal of Pediatric Nursing, 12(1), 21–31. https://doi.org/10.1016/S0882-5963(97)80018-8
66. Subic-Wrana, C., Beutel, ME., Knebel, A., & Lane., RD. (2010). Theory of mind and emotional awareness deficits in patients with somatoform disorders. Psychosomatic Medicine, 72(4), 404–411. https://doi.org/10.1097/PSY.0b013e3181d35e83
67. Şar, V., Öztürk, E., & İkikardeş, E. (2012). Validity and reliability of the Turkish version of Childhood Trauma Questionnaire (CTQ). Turkiye Klinikleri Journal of Medical Sciences, 32(4), 1054–1063. https://doi.org/10.5336/medsci.2011-26947
68. Şar, V., Necef, I., Mutluer, T., Fatih, P., & Türk-Kurtça, T. (2021). A revised and expanded version of the Turkish childhood trauma questionnaire (CTQ-33): Overprotection-overcontrol as additional factor. Journal of Trauma & Dissociation, 22(1), 35–51. https://doi.org/10.1080/15299732.2020.1760171
69. Tajima, E. A. (2000). The relative importance of wife abuse as a risk factor for violence against children, Child Abuse & Neglect, 24(11) 1983-93. https://doi.org/10.1016/S0145-2134(00)00194-0
70. Talmon, A., Uysal, A., & Gross, J. J. (2022). Childhood maltreatment and mid-life adults sexuality: A 10-year longitudinal study. Archives of Sexual Behavior, 51(2), 781–795. https://doi.org/10.1007/s10508-021-02030-8
71. Terr, L. C. (1995). Childhood traumas: An outline and overview. In G. S. Everly, & J. M. Lating (Eds.), Psycho traumatology: Key papers and core concepts in post-traumatic stress (pp. 301-320). Springer.
72. Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2/3), 25–52. https://doi.org/10.2307/1166137
73. Thompson, K. L., Hannan, S. M., & Miron, L. R. (2014). Fight, flight, and freeze: Threat sensitivity and emotion dysregulation in survivors of chronic childhood maltreatment. Personality and Individual Differences, 69, 28–32. https://doi.org/10.1016/j.paid.2014.05.005
74. Thornberry, T. P., Matsuda, M., Greenman, S. J., Augustyn, M. B., Henry, K. L., Smith, C. A., & Ireland, T. O. (2014). Adolescent risk factors for child maltreatment. Child Abuse & Neglect, 38(4), 706-722. https://doi.org/10.1016/j.chiabu.2013.08.009
75. Tsai, J. K., Lu, W. H., Hsiao, R. C., Hu, H. F., & Yen, C. F. (2020). Relationship between difficulty in emotion regulation and internet addiction in college students: A one-year prospective study. International Journal of Environmental Research and Public Health, 17(13), 4766. https://doi.org/10.3390/ijerph17134766
76. Tüccaroğlu, N. B. (2021). Üniversite öğrencilerinde çocukluk çağı travmaları ile duygu düzenleme güçlüğü ve öz şefkatin incelenmesi (Investigation of childhood traumas, emotion dysregulation and self-compassion in university students) [Master Thesis, İstanbul Gelişim University]. İstanbul Gelişim University Libraries. https://hdl.handle.net/11363/3062
77. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2022). Child Maltreatment 2020. Available from https://www.acf.hhs.gov/cb/data-research/child-maltreatment.
78. World Health Organization. (2020, June 8). Child maltreatment. Retrieved August 24, 2022, from https://www.who.int/news-room/fact-sheets/detail/child-maltreatment
79. Yiğit, İ., Guzey-Yiğit, M. (2019). Psychometric properties of Turkish version of difficulties in emotion regulation scale-brief form (DERS-16). Current Psychology, 38, 1503–1511. https://doi.org/10.1007/s12144-017-9712-7
80. Yoon, S., Yoon, D., Latelle, A., & Kobulsky, J. M. (2022). The interaction effects between father-child relationship quality and parent-perpetrated maltreatment on adolescent behavior problems. Journal of Interpersonal Violence, 37(17-18). https://doi.org/10.1177/08862605211021977
81. Zeren, C., Yengil, E., Çelikel, A., Arık, A. & Arslan, M. (2012). Üniversite öğrencilerinde çocukluk çağı istismarı sıklığı [Frequency of childhood abuse in university students]. Dicle Tıp Dergisi, 39 (4), 536-541. https://doi.org/10.5798/diclemedj.0921.2012.04.0196
82. Zoroğlu, S. S., Tüzün, Ü., Şar, V., Öztürk, M., Eröcal-Kora, M., & Alyanak, B. (2001). Çocukluk dönemi istismar ve ihmalinin olası sonuçları [Probable results of childhood abuse and neglect]. Anadolu Psikiyatri Dergisi, 2(2), 69-78.